Table Of Content
Introduction
Cancer in the ovaries due to abnormal multiplication and division of ovarian cells (proliferation) is called ovarian cancer. The female reproductive system consists of two walnut-sized ovaries responsible for producing eggs and sex hormones.
How Does Ovarian Cancer Develop?
Ovarian cancer develops when cells in the ovaries or surrounding structures develop mutations (changes) in their DNA. This leads to multiplying the cells in an abnormal and uncontrolled manner. These cells can also affect nearby tissues or other parts of the body.
Types of Ovarian Cancer
The different ovarian cancer types are:
1. Epithelial ovarian cancer: This type of ovarian cancer occurs on the surface of the ovary. It is otherwise also known as epithelial ovarian carcinoma. It is further divided into the following four types:
- Serous Carcinomas
- Endometrioid Carcinomas
- Clear cell carcinomas
- Mucinous carcinomas
2. Germ cell ovarian tumors: This cancer begins in the cells of the ovaries that form the eggs (germ cells). It is further divided into the following types:
- Dysgerminoma
- Immature Teratomas
- Mature teratomas
- Endodermal sinus tumors or yolk sac tumors
3. Sex Cord-Stromal Tumors: Tumors that begin in the sex cords or the stroma is called sex cord stromal tumors. There are various types of sex cord stromal tumors. These tumors can be benign (noncancerous) or malignant (cancerous). Sex cord stromal tumors are further divided into the following types,
- Sertoli-Leydig Cell Tumor
- Adult Granulosa Cell Tumor
- Juvenile Granulosa Cell Tumor
- Gynandroblastoma
- Granulosa and Sertoli-Leydig cell tumor
- Granulosa and Sertoli cell tumor
- Malignant Mixed Müllerian Tumor
4. Borderline Epithelial Tumors: In this type, abnormal cells form around the tissue that covers the ovary. They are not cancerous and can usually be cured using surgery
Stages of Ovarian Cancer
The various stages based on which the doctor determines the progress, prognosis, and treatment of ovarian cancer are:
Stage I: This is the early stage of ovarian cancer and is further divided into the following three substages. They are,
- Stage IA: In this stage, the cancer is limited to one ovary.
- Stage IB: In this stage, the cancer is present in both ovaries.
- Stage IC: In this stage, the cancer cells are present outside the ovaries. This stage is further divided into the following,
▪ Stage IC1: This stage indicates the presence of cancer in one or both ovaries, and the cancer cells have leaked into the belly or pelvic region during the tumor removal surgery.
▪ Stage IC2: This stage indicates the presence of cancer in one or both ovaries or the tumor has ruptured, causing the cancer cells to leak before surgery.
▪ Stage IC 3: This stage indicates the presence of cancer in one or both ovaries, and cancer cells are taken from the fluid inside the abdomen while performing surgery.
Stage II: In this stage, cancer has grown beyond the ovaries and has spread into the pelvic region. This stage is further divided into subtypes. They are:
- Stage IIA: In this substage, cancer has grown into the fallopian tubes or the uterus or both.
- Stage IIB: In this stage, cancer has grown and spread into the surrounding organs in the pelvis, like the colon, bladder, or rectum.
Stage III: This stage is further divided into the following,
- Stage IIIA: In this stage, cancer has spread into the surrounding lymph nodes and might be growing in the surrounding organs. This stage is further divided into the following,
▪ Stage IIIA1: This stage indicates the spread of cancer into the nearby lymph nodes behind the abdomen.
▪ Stage IIIA2: This stage indicates that your doctor saw your cancer in the belly (abdomen) while performing surgery. Cancer might have also spread in the lymph nodes. - Stage IIIB: This stage means that the cancer size is less than or up to 2 cm and is lining the peritoneum (abdomen). Cancer might have also spread in the lymph nodes.
- Stage IV: This stage consists of two substages. They are,
▪ Stage IVA: In this substage, the cancer cells have spread into the fluid surrounding the lungs, but it has not spread into any other areas beyond the abdomen or pelvis.
▪ Stage IVB: Cancer in this stage has spread in the lymph nodes, tissues, and organs. These organs may include the brain, skin, and lungs.
Causes & Risk Factors of Ovarian Cancer
The exact causes of ovarian cancer are not known. However, there are certain risk factors associated with ovarian cancer. They are:
- Family history of ovarian cancer: Having a family member who has had ovarian cancer poses a risk factor.
- Gene mutations leading to acquired cancer: Certain genetic changes acquired from parents or having BRCA1 and BRCA2 genes can also increase the risk of ovarian cancer.
- Old age: The risk of ovarian cancer increases with age.
- Obesity: Being obese or overweight increases the risk of developing ovarian cancer.
- Late pregnancy or no pregnancy at all: Never having been pregnant or late pregnancy also acts as a risk factor for ovarian cancer.
- Family history of breast or colorectal cancer: Having a family member who has had breast or colorectal cancer also acts as a risk factor.
- Hormone replacement therapy postmenopause: Women taking hormone replacement therapy after menopause are at risk of getting ovarian cancer.
- Endometriosis: Having endometriosis increases the risk of ovarian cancer.
Symptoms of Ovarian Cancer
The symptoms of ovarian cancer are not very prominent in the early stage. If any symptoms develop, cancer spreads throughout the abdomen. However, when symptoms do become visible, the following can be seen:
- Pain and discomfort in the abdomen and pelvic region
- Regular bloating
- Feeling full immediately when eating
- Loss of appetite
- Unusual or abnormal vaginal bleeding or discharge
- Diarrhea or constipation
- Frequent need to urinate
- Unusual weight gain or weight loss
- Unusual lumps or increased size of the abdomen
- Feeling fatigued
- Pain in the lower back
- Pain during sex
Ovarian Cancer Screening
Ovarian cancer screening can be done using the following test:
- Regular health examination: Getting a pelvic examination done regularly might help in the early finding of cancer. Although ovarian cancers are difficult to find in the early stage, regular pelvic examination by a doctor can help in finding other cancers or problems.
Ovarian Cancer Diagnosis
There are various tests available to diagnose ovarian cancer. These tests include:
1. Medical history and physical examination: During the medical history and physical examination, a doctor will ask about all the possible risk factors, like family history and personal history, to find the reason behind ovarian cancer. The doctor might also ask for the symptoms experienced based upon which further tests might be prescribed.
2. Ultrasound: Usually, ultrasound is one of the very first tests that is performed in order to check any problem in the ovaries. This ultrasound test will show all the growths, including ovarian tumors or any fluid-filled cysts present, which might be cancerous or noncancerous.
3. Imaging tests: Various imaging tests like MRI scan, PET scan, or CT scan may also be conducted to check for ovarian cancer as well as see how much it has spread to the other tissues and organs.
4. Chest x-ray: A chest x-ray is usually conducted to see if ovarian cancer has spread into the lungs or not.
5. Laparoscopy: This test helps the doctor in viewing the ovaries and the other organs of the pelvis area.
6. Biopsy: It is the only test that might help in finding out if a growth seen is cancer or not. In this test, the doctor removes a piece of the growth and examines it. In certain instances, a biopsy is done during surgery.
7. Genetic testing: Using the genetic testing procedure, the doctor will examine the blood to look for any genetic changes that might increase the risk of ovarian cancer.
8. Blood tests: These tests will be performed by the doctor to check the overall patient health.
Treatment of Ovarian Cancer
Depending on the individual's overall health, the type and size of cancer, and the patient's preference, the doctor may recommend treatment options. The various treatment options available to treat ovarian cancers include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted drug therapy. You may receive one or a combination of these treatment types if you have ovarian cancer.
Surgery: Surgery is the major treatment option for most ovarian cancers. However, whether to perform surgery or not is dependent upon the stage of cancer and the patient's overall health. If the cancer is detected in its early stages, it might be possible to treat it without the need to remove the ovaries and the uterus. The surgeries for ovarian cancer include,
- Surgery for removing one ovary: If the cancer is detected in its early stage and if it hasn't spread beyond one ovary, then surgery might be performed to remove the affected ovary and the fallopian tube. The surgery may help in preserving the ability to conceive in the future.
- Surgery for removing both ovaries: When the cancer spread is seen in both ovaries and in case there are no signs of additional cancer, then the doctor might perform surgery to remove both ovaries with the fallopian tubes. The uterus might not be removed.
- Surgery for removing both of the ovaries and uterus: When cancer has spread beyond the ovaries and into the uterus, then the surgery might be performed to remove both the ovaries, fallopian tube, and the uterus along with the surrounding lymph nodes.
- Surgery for advanced ovarian cancer: When the cancer is extremely advanced, then surgery might be recommended to remove cancer as much as possible. In this case, chemotherapy is usually given before or after surgery.
Chemotherapy: Chemotherapy treatment involves using medications that destroy the cancer cell. Chemotherapy for treating ovarian cancer can be given alone or in combination with other cancer treatments. The effectiveness of radiation therapy is often increased by chemotherapy, and hence the two are usually given in combination.
- Intraperitoneal (IP) chemotherapy: When ovarian cancer is in stage 3, Intraperitoneal (IP) chemotherapy might be given. In this, the chemotherapy therapy drugs might be placed/ injected into the abdominal cavity using a catheter. It might the placed either during surgery or maybe later
Radiation Therapy: Radiation therapy involves using high beams of X-rays or protons targeted toward the cancer cells to destroy them.
Targeted Therapy: In this treatment approach, medications are used to specifically identify and target cancer cells without causing damage to the healthy cells. These medications target the proteins that help the cancer cells grow and spread.
Immunotherapy: Our disease-fighting immune system can identify and destroy any abnormal cells and prevent some cancerous growth. But cancer cells blind the immune system and prevent it from attacking them due to their genetic changes and proteins. Immunotherapy treatment helps the immune system in combating cancer. This method of treatment is otherwise also called biological therapy.
Prognosis of Ovarian Cancer:
The relative 5-Year Survival Rate for ovarian cancer based on stages is:
- Stage I: 90%
- Stage II: 70%
- Stage III: 39%
- Stage IV: 17%
Prevention of Ovarian Cancer
Ovarian cancer can be prevented by reducing the risk factors. Where certain factors like age, family history, or personal history are not in our control, controlling certain risk factors lie in our hands, and modifying them or reducing them can help prevent ovarian cancer. These include:
- Maintaining a healthy weight
- Exercising regularly
- Eating a healthy diet
Ovarian Cancer FAQs
1. In which stage is ovarian cancer the most curable?
Ovarian cancer, when detected in its stage I, has a great prognosis, as stage I patients have a five years survival rate of 90%.
2. Will I get pregnant if I have ovarian cancer?
There are chances of pregnancy even if you have been diagnosed with ovarian cancer. You may talk to your doctor if you have any pregnancy-related concerns. Your doctor will recommend different methods to preserve fertility before cancer treatment begins.
3. What are the symptoms of ovarian cancer for early detection?
The symptoms of ovarian cancer are not very prominent in the early stage. If any symptoms develop, cancer spreads throughout the abdomen. However, when symptoms do become visible, the following can be seen,
- Pain and discomfort in the abdomen and pelvic region
- Regular bloating
- Feeling full immediately when eating
- Loss of appetite
- Unusual or abnormal vaginal bleeding or discharge
- Diarrhea or constipation
- Frequent need to urinate
- Unusual weight gain or weight loss
- Unusual lumps or increased size of the abdomen
- Feeling fatigued
- Pain in the lower back
- Pain during sex
4. Is removing the ovaries the only solution for ovarian cancer?
No, removing the ovaries in ovarian cancer surgery is done only when cancer has spread into both ovaries.
5. My family member had ovarian cancer. Am I also at risk?
Yes, having a family history of ovarian cancer acts as a risk factor for developing ovarian cancer.
6. Is there a connection between breast cancer and ovarian cancer?
Yes, there is a connection between breast cancer and ovarian cancer. BRCA1 and BRCA2 genes known to increase the risk of developing breast cancer are also associated with an increased risk of ovarian cancer.
7. What can I do to decrease my risk of ovarian cancer?
Yes. You can reduce your risk of developing ovarian cancer by healthy eating, exercising regularly, and maintaining a healthy weight.
References
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